Claims Audit & Analysis

• Exponential Business growth
• Volume flow is highly unpredictable
• Lack of trained resources

The current engagement is in the Data Mining business, with Data Marshall providing Claims Audit & Analysis. The process involves Claim review, analysis, research & Provider contact. The engagement would entail Data Marshall to perform the Claims Audit function & allied services, from its premises in India.

Solution:

• Offered an offshore delivery model for meeting the Claims Audit and Analysis.
• Provided flexible staffing models to be able to absorb the fluctuation in volumes and deliver higher refunds than experienced onsite analysts.
• Established effective process methodology to increase refunds in line with six-sigma practice in a short span of time.
• Designed a KM Tool to realize higher refunds & quality with the implementation of DMAIC methodology.
  

• Offshore team started with 10 resources and has grown to 21 resources
• Provided cost savings in excess of 50 %
• Delivered services at accuracy levels greater than 99.5 %
• Team identifying in excess of 2 MILLION USD every month as contractual over payments made by leading insurance companies.